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Multicenter Study
. 2025 Oct 1;107-B(10):1118-1124.
doi: 10.1302/0301-620X.107B10.BJJ-2024-1448.R1.

The impact of complications on quality of life and mortality after hip fracture

En Lin Goh  1 , May Ee Png  2 , David Metcalfe  1 , Juul Achten  1 , Duncan Appelbe  1 , Xavier L Griffin  3 , Jonathan A Cook  4 , Matthew L Costa  1 ; WHiTE Investigators
Collaborators, Affiliations
Multicenter Study

The impact of complications on quality of life and mortality after hip fracture

En Lin Goh et al. Bone Joint J. .

Abstract

Aims: There is limited information on how the development of complications influences quality of life (QoL) after hip fracture. The aim of this study was to investigate the relationship between complications, QoL, and mortality after hip fracture.

Methods: The World Hip Trauma Evaluation (WHiTE) study is a multicentre, prospective cohort study that collected data from patients aged ≥ 60 years who received surgical treatment for their hip fracture. Patients were followed up for 120 days after surgery. The primary and secondary outcomes were health-related QoL (EuroQol five-dimension five-level questionnaire; EQ-5D-5L) and mortality, respectively. Linear and logistic regression models were fitted to assess the relationship between complications, EQ-5D-5L, and mortality.

Results: Among 24,523 patients with a hip fracture, the mean differences in EQ-5D-5L in patients who had surgery-specific complications were: prosthesis dislocation -0.14 (95% CI -0.20 to -0.08); fixation failure 0.00 (95% CI -0.15 to 0.14); periprosthetic or peri-implant fracture -0.08 (95% CI -0.18 to 0.02); reoperation for any indication -0.09 (95% CI -0.14 to -0.05); surgical site infection (SSI) -0.06 (95% CI -0.10 to -0.01); and deep SSI -0.13 (95% CI -0.20 to -0.07). The mean differences in EQ-5D-5L for the general complications were: acute kidney injury -0.05 (95% CI -0.07 to -0.02); blood transfusion -0.01 (95% CI -0.03 to 0.01); lower respiratory tract infection -0.07 (95% CI -0.09 to -0.05); urinary tract infection 0.01 (95% CI -0.01 to 0.03); cerebrovascular accident (CVA) -0.17 (95% CI -0.25 to -0.09); myocardial infarction (MI) -0.14 (95% CI -0.20 to -0.08); and venous thromboembolism 0.03 (95% CI -0.02 to 0.08).

Conclusion: We observed worse health-related QoL in patients who had a complication after hip fracture. Those who underwent revision surgery or had a prosthesis dislocation or deep SSI experienced similar levels of disability at 120 days to those with a CVA or MI.

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Conflict of interest statement

E. L. Goh reports a doctoral research fellowship from the National Institute for Health and Care Research (NIHR), which enabled research for this study. J. Achten reports funding from the NIHR Oxford Biomedical Research Centre, related to this study as well as grants or contracts from the NIHR, unrelated to this study. D. Appelbe reports funding from the NIHR Health Technology Assessment (HTA), related to this study. D. Metcalfe reports an Advanced Fellowship from the NIHR, and an infrastructure grant from the Kadoorie Charitable Foundation, both paid to University of Oxford and not related to this study. X. L. Griffin reports funding from the NIHR Research for Patient Benefit (RfPB), related to this study, as well as multiple grants from UK Research and Innovation (UKRI) and charity, unrelated to this study. J. A. Cook reports funding from the NIHR, related to this study. M. L. Costa reports funding from the NIHR and the Wellcome Trust, unrelated to this study.

References

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